Provider Demographics
NPI:1275097917
Name:JOHNSON, CHRISTOPHER F JR
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:F
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 GREENBRIAR DR APT 214
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6221
Mailing Address - Country:US
Mailing Address - Phone:309-310-4881
Mailing Address - Fax:
Practice Address - Street 1:403 GREENBRIAR DR APT 214
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6221
Practice Address - Country:US
Practice Address - Phone:309-310-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer